Kingston Learning Centre Application for Enrolment
742 Arlington Park Place, Kingston, ON   K7M 8H9
Phone: 613-384-6194 * Fax: 613-384-9459 * Toll: 1-888-732-0326 * Email:klc@cogeco.net   
Private Career College registered under the Private Career Colleges Act, 2005

PERSONAL INFORMATION

STEP 2 - COMPLETE THE APPLICATION FORM
ALL FIELDS MUST BE COMPLETED!

NAME OF APPLICANT:


Surname   First Name(s)
Address:
  Street    
 
  City Province Postal Code

Home Phone:
please enter as 613-123-1234 		 
Email:
  
DATE OF BIRTH: (YYYY/MM/DD)  
Primary Language:
  
Emergency Contact Name:  

Contact Number:

  

Have you ever been convicted of a criminal offense for which you have not been granted a pardon?
           no     yes

I understand that I may be required to provide a current Criminal Record Search for the program I am requesting.

PROGRAM INFORMATION

Program Name: Pharmacy Assistant - Smiths Falls Campus
Campus Location: Smiths Falls


               
Start Date: to be determined
(yy/mm/dd)

 

Completion Date: to be determined
(yy/mm/dd)

NOTE: submission of this Application for Enrolment does not guarantee a reserved space or acceptance in the above stated program.

ACADEMIC INFORMATION

Have you ever applied to this private career college before?  no         yes

If Yes, for which year?     (XXXX)

I am applying as an International Student

Highest Level of education received, please check one:

Grade 12
Post-Secondary Certificate or Diploma
Other: specify grade level     
I am applying as a Mature Student
-(requires CAAT testing prior to admission and must be 18 years of age and out of school for at least 2 years)

METHOD OF PAYMENT

Have you set aside money for your education?     no     yes

Will you require financial assistance?       no yes


Check one of the following statements as it relates to you.

I will pay for my entire term charges on receipt of my enrolment contract
I will remit payments for my term charges on receipt of my enrolment contract
Please select method of payment(s) either:
            POST DATED CHEQUES        OR     CREDIT CARD
  I will remit payments for my term charges on receipt of my enrolment contract
Please select method of payment(s) either: post-dated cheques OR credit card
I will provide a letter from an authorized company or agency confirming that they will pay my entire charges and may be invoiced directly:
Name of Company/Agency:      
I will by applying for a government student loan
I will be applying for funding through the Employment Insurance (EI) program:

 

Do you wish to speak to the Financial Administrator?        no       yes    

An Enrolment Contract will be issued to the applicant providing the applicant meets all entrance requirements and provides detailed information on the terms of their tuition payment(s). Sponsored applicants must provide written approval from their sponsors prior to entering into contract with the Kingston Learning Centre.

Application Date: 2010/Sep/09

Revised 2008-04-09